permissions@oup.com.The most frequently performed low-flow bypass procedure is the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. If available, a suitable M2 or M3 cortical branch is anastomosed to the donor vessel. This patient had severe moyamoya disease with an ipsilateral perfusion deficit and transient ischemic attacks. Given the need for revascularization, an STA-to-MCA bypass was performed. There was no suitable recipient M3 branch for direct anastomosis, and therefore an indirect bypass was performed by onlaying the STA onto the cortical surface and suturing the adventitia of the STA to the arachnoid of the underlying cortex. The dural leaflets were then inverted to potentiate further revascularization of the underlying cortex. https://www.selleckchem.com/products/arq531.html The patient remained at their neurological baseline and demonstrated an enhanced perfusion of the ipsilateral MCA territory on follow-up evaluation. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona. Copyright © 2020 by the Congress of Neurological Surgeons.BACKGROUND The risk of interlaminar passage of a dilator into the cervical spinal canal in minimally invasive approaches is currently unknown. Among the various anthropometric data reported in the literature, there is no report of the interlaminar dimensions in the cervical spine. OBJECTIVE To report the cervical interlaminar dimensions in neutral, flexion, and extension. METHODS A total of 8 spines were sectioned into cervical (C2-T1) segments. Digitized coordinate data defining the locations and movements of chosen anatomic points on the laminar edges at a given spinal level were used to compute the dimensions during a static neutral posture, flexion, and extension positions to mimic the positions during surgery. Interlaminar dimensions were averaged and categorized for each vertebral level and spinal posture. RESULTS Based on the reported measurements, the smallest diameter dilator in commonly used dilator sets has the potential to traverse the interlaminar space at all levels in flexion. In a neutral posture, the average interlaminar distance at C2-3, C6-7, and C7-T1 was still greater than 2.0 mm, the smallest diameter of the initial dilator. The largest interlaminar distance was at C6-7 in flexion (7.68&nbsp;±&nbsp;1.60 mm). CONCLUSION Because dilators pass directly onto the cervical lamina without visualization of the midline structures, the interlaminar distances have increased relevance in the minimally invasive cervical approaches of foraminotomy and laminectomy. The data in this report demonstrate the theoretical risk of interlaminar passage with small diameter dilators in posterior minimally invasive approaches to the cervical spine. Copyright © 2020 by the Congress of Neurological Surgeons.Polypharmacy (use of ?5 medications) and increasing Drug Burden Index (DBI) score (measure of person's total exposure to anticholinergic/sedative medications) are associated with impaired physical function in observational studies of older adults. Deprescribing, the supervised withdrawal of medications for which harms outweigh benefits for an individual, may be a useful intervention. Current knowledge is limited to clinical observational studies that are unable to determine causality. Here, we establish a preclinical model that investigates effects of chronic polypharmacy, increasing DBI and deprescribing on global health outcomes in ageing. In a longitudinal study, middle-aged (12 months) male C57BL/6J (B6) mice were administered control feed or feed and/or water containing polypharmacy or monotherapy with different DBI scores. At 21 months, each treatment group was subdivided (stratified by frailty at 21 months) to either continue on treatment for life or to have treatment withdrawn (deprescribed). Frailty and physical function were evaluated at 12, 15, 18 and 24 months, and were analysed using a mixed modelling approach. Polypharmacy with increasing DBI and monotherapy with citalopram caused mice to become frailer, less mobile and impaired their strength and functional activities. Critically, deprescribing in old age reversed a number of these outcomes. This is the first preclinical study to demonstrate that chronic polypharmacy with increasing DBI augments frailty and impairs function in old age, and that drug withdrawal in old age reversed these outcomes. It was not the number of drugs (polypharmacy) but the type and dose of drugs (DBI) that caused adverse geriatric outcomes. © The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.The world population is ageing because of falling fertility and improved life expectancy. Knowing this has not helped governments develop sustainable health and care policies because the underlying causes and impacts of population ageing remain poorly understood. Planning using only population age structure does not account for uneven geographical distribution of older people, their health characteristics, functional needs or lived experiences. English National Health Service (NHS) policy has previously focused on arbitrary age segmentation, failing to capture the origins of cumulative disease and functional burden and missing the opportunity to incorporate wider determinants of health into prevention of poor-quality ageing. This is despite growing international evidence that adults living in places with low per capita income and educational attainment experience a higher burden of age-related disease. Lack of a credible ageing narrative and good quality population health data have contributed to a focus on single disease prevention, rather than life course disease aggregation and its personal impacts. However, a fully explicated health and care narrative incorporating frailty does now give some cause for optimism. In 2017, England became the first country to characterise and systematically identify frailty as a long-term treatable health condition. This was coincident with a UK Government's Industrial Strategy targeting societal ageing. In 2019, the English NHS published a funded long-term plan including a major programme focused on ageing well. Policy makers, health leaders and clinicians must not squander these opportunities but instead pursue frailty prevention and intervention to improve the quality of population ageing. © The Author(s) 2020. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. 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